Rear Admiral Tim Ziemer

IMPACT: What is the role of the private sector in controlling malaria?

TIM ZIEMER: When discussing the private sector, we have to understand what exactly you mean by private sector. Do you mean licensed pharmacies? Do you mean the private sector that produces nets, anti-malaria drugs, rapid diagnostic kits and insecticides? Or do you mean the mom-and-pop stores that sell tires, cooking oil and anti-malarial drugs? The role of the private sector in all three of those areas is critical.

We’re heavily dependent on the private sector to produce and maintain malaria prevention and interventions. In many of the African countries 50 to 60 percent of health services are provided by the private or the faith-based component. However, when it comes to the mom-and-pops, due to the concerns about safety and the existence of pirated anti-malarial drugs, we have to ensure that the drugs are dispensed by appropriate vendors.

IMPACT: Do you think the Affordable Medicines Facility - malaria (AMFm) model can address issues around the availability of artemisinin-based combination therapies (ACTs)?

TZ: The U.S. government is fully supportive of providing safe, effective ACTs at a very low cost to those who need it the most. But when you look at the AMFm model and what it aspires to do and how to get there, it begs a number of questions. The eight or nine countries where AMFm is currently modeled need to produce evidence that is so compelling that donor nations fund a subsidy program like it. However, if the evidence isn’t there, AMFm will not be continued.

The evidence also has to show that AMFm is marginalizing or shouldering out monotherapies. However, in many cases like Rwanda, it’s really through political leadership and national leadership that monotherapies have been taken off the shelves. So we have to look at all the different angles and what is consistent with country plans before we fully support something like AMFm.

IMPACT: What is PMI doing to support the containment of artemisinin resistance developing in Southeast Asia and, longer term, to reduce the risk of resistance developing elsewhere?

TZ: The World Health Organization (WHO) just released a global plan to combat resistance, and the U.S. government is supportive of it. We fund the program in the region and intend to continue working with other donors and technical partners such as the Bill & Melinda Gates Foundation, the U.K. Department for International Development (UKaid), WHO and the four or five countries where the resistance is evident to determine the scope and range of the resistance and the appropriate action needed to confine and reduce the resistance. We are also supporting strengthening of systems to deliver more effective case management of malaria and to improve supply of good quality drugs, as well as research to develop new drugs to treat malaria.

IMPACT: Considering the realities in countries such as Nigeria and the Democratic Republic of Congo, is it a priority to focus resources on malaria elimination?

TZ: None of the 15 countries where PMI works is in the pre-elimination phase. A few countries, like Senegal, are bumping up against pre-elimination. As the country sees the success of its prevention and treatment program and sees sectors or districts nearing a pre-elimination phase, then its national plan has to address that, and we will continue working together. But when we get to the discussion of elimination, we have to look at the global malaria action plan. At the end of World War II, there were 200 countries that had malaria. Today, we have 104. So we are making progress. The real question is how do we continue to make progress so that we go from a prevention and treatment phase to a sustained control phase and eventually to an elimination phase?

IMPACT: What needs to happen over the next five years to achieve the Roll Back Malaria goal of near zero malaria deaths across the globe by 2015? And what needs to happen after that?

TZ: The goal of near zero malaria deaths by 2015 is pretty ambitious. But the fact is that we can do it. We know what causes malaria, we know how to prevent it and we know how to treat it. If we can get the national governments behind their plans, continue to use available resources for effective prevention and treatment we have today, and more importantly, develop a very robust case management program to diagnose fevers, identify malaria and treat it with ACTs, we can get there.

This interview has been edited for length and clarity.

Watch the full interview between Rear Admiral Ziemer and Marshall Stowell below or directly on YouTube.